How Diabetes Affects Your Feet
Your feet should have been one of the first things on your mind if you’ve been told you have diabetes.Diabetes changes the way your body responds to pressure, injury and infection, and your feet bear the brunt of it single day.
Getting on top of foot care early makes a real difference - and for most people it comes down to: wearing the right shoes, having your feet checked regularly and knowing what to look for between appointments.
At Foot Balance Technology, our team includes pedorthists and podiatrists who specialise in high-risk foot care, including diabetes. We work closely with GPs, endocrinologists and other health professionals to keep your feet protected at every stage of your diabetes journey.
This guide covers everything from understanding your risk level to funding your footwear through the NDIS.
Diabetic Foot Care and Why It Matters
Diabetic foot care covers the ongoing monitoring, treatment and protection of your feet when you have diabetes. The reasons run deeper than most people realise.
The problem with diabetes and your feet is that two things can go wrong at the same time. Nerve damage means you may not feel a blister or sore developing. Poor circulation means that when something does go wrong, your body struggles to heal it. That combination is what makes diabetic foot complications so serious - and so worth preventing.
According to Diabetes Australia, around 1.5 million Australians are living with diabetes, and foot complications are among the most common and costly consequences. Yet many are preventable. A 2024 clinical audit in PLoS One by Dr Sayed Ahmed, Alex Barwick, Anita Sharma, Md Zobaer Hasan, Muhammad Ashad Kabir and Susan Nancarrow found that people receiving pedorthic services presented with a wide range of diabetes-related foot conditions, reinforcing how central footwear and orthotic intervention is across all stages of the condition.
Diabetic foot care combines professional assessment, appropriate footwear, daily self-monitoring and a team of health professionals who understand the condition well.
Understanding Your Risk with the IWGDF System
The International Working Group on the Diabetic Foot (IWGDF) developed a risk classification system that helps clinicians and patients understand how closely feet need to be monitored.
There are four risk levels, from 0 to 3:
| Rick Level | What It Means | Recommended Check-up Frequency |
| 0 | No neuropathy detected | Once a year |
| 1 | Neuropathy present, but no deformity or PAD | Every 6 months |
| 2 | Neuropathy plus foot deformity or peripheral arterial disease (PAD) | Every 3 months |
3 | Previous ulcer or amputation | Every 1–3 months |
Your risk level can change over time, particularly as diabetes progresses. That's why it's worth getting your feet checked even when everything seems fine - because by the time something feels wrong, the window for early action may have already passed.
Knowing your IWGDF risk level helps determine what kind of footwear and offloading support you need. A pedorthist uses this information, alongside a full assessment of your foot structure and pressure patterns, to guide the right prescription for you.
Neuropathy and Peripheral Arterial Disease in Diabetes
Diabetic Neuropathy
Neuropathy means nerve damage. High blood sugar levels gradually damage the nerves in your feet and lower legs, resulting in a loss of sensation. You may not feel heat, cold, pressure or pain normally.
The tricky part about neuropathy is that you can have a wound developing and not feel a thing. By the time you notice something is wrong, it may already be infected. It can also gradually change the shape of your foot and the way you walk, creating new pressure points..
Peripheral Arterial Disease
PAD is essentially a circulation problem. The arteries supplying blood to your legs and feet narrow over time, which means that even a small cut struggles to heal properly. People sometimes notice cramping when they walk, or that their feet feel cold or look discoloured - signs worth mentioning to your doctor.
The two conditions frequently occur together, which is why a thorough diabetic foot assessment looks at both nerve function and circulation.
How Screening Works with Monofilament and ABI Testing
Two simple tests give clinicians a clear picture of how diabetes is affecting your feet. Neither is painful, and both can be done in a standard clinical setting.
The 10g Monofilament Test
A thin, flexible filament is pressed against different points on the sole of your foot. If you can't feel it at one or more points, that's a sign of sensory neuropathy. The test is quick, inexpensive and recommended as part of every routine diabetic foot assessment.
The Ankle-Brachial Index Test
The ABI test measures blood flow by comparing blood pressure at your ankle with blood pressure at your arm. A normal result sits between 1.0 and 1.4 - a reading below 0.9 suggests your circulation is reduced, which can indicate peripheral arterial disease.
It's a straightforward test. A blood pressure cuff and a small handheld probe are all that's needed, and it takes about 15 minutes.
Between the monofilament and the ABI test, a clinician gets a much more complete picture of what's actually going on in your feet - information that shapes how often you need to be seen and what kind of footwear will best protect you.
Roles of the Pedorthist and the Podiatrist
If you're managing diabetes, you'll likely meet both pedorthists and podiatrists during your care. They work closely together, but their roles are distinct and it helps to understand what each one brings to the table.
| Pedorthist | Podiatrist | |
| Primary focus | Footwear and orthotic prescription | Diagnosis and clinical treatment of foot conditions |
| What they assess | Foot shape, pressure distribution, gait and footwear fit | Skin, nails, circulation, nerve function and biomechanics |
| What they provide | Custom footwear, modified shoes, insoles, AFOs | Medical treatment, wound care, nail surgery, orthotics |
Referrals | Often referred by podiatrists, GPs or specialists | Can refer to pedorthists and other specialists |
Medicare | Not currently covered under standard Medicare | Covered under Enhanced Primary Care plans via GP referral |
IThe two work closely together. A podiatrist might pick up neuropathy or a pressure hotspot and then bring in a pedorthist to sort out the right footwear. At FBT, both are available in the same clinic.
Dr Sayed Ahmed, who founded FBT, holds Australia's first PhD in Pedorthics, a credential that speaks for itself.
The FBT Approach to Footwear and Offloading
For someone living with diabetes, footwear selection is one of the most important clinical decisions they'll make. The wrong pair can trigger an ulcer. The right pair can stop one from ever developing.
A 2020 systematic review by Dr Sayed Ahmed, Alex Barwick, Paul Butterworth and Susan Nancarrow, published in the Journal of Foot and Ankle Research, looked at exactly what makes diabetic footwear effective. The findings were specific - this isn't about buying a shoe with a "diabetic" label on it, it's about design features that actually do a job.
Those features include:
- Extra depth and volume to accommodate foot deformities and custom insoles without creating pressure points
- Rocker-sole construction to reduce peak pressure under the forefoot during walking
- Custom moulded insoles that spread weight evenly across the foot rather than concentrating it in vulnerable areas
- Soft, seamless linings to reduce friction against skin that may not feel damage occurring
- Adjustable fastenings to account for swelling and changes in foot shape
- Ankle foot orthoses (AFOs) for people with Charcot foot or significant instability
At FBT every footwear prescription starts with a full biomechanical assessment and plantar pressure mapping. This tells us where your foot is under the most stress, so we can select or design medical-grade footwear that targets those areas specifically.
A 2022 study protocol in Trials by Dr Ahmed, Paul Butterworth, Alex Barwick, Anita Sharma, Md Zobaer Hasan and Susan Nancarrow explored how plantar pressure data can guide the manufacture of bespoke footwear for people at high risk of forefoot ulceration - reinforcing that getting this right is a precision process.
Not everyone needs the same solution. Options range from custom insoles and bespoke footwear through to removable cast walkers and total contact casts for more acute situations. What's right for you depends on your IWGDF risk level, your foot structure and how you live day to day.
The FBT Approach to Footwear and Offloading
Foot ulcers are serious, but are very treatable when caught early. Knowing about how they're assessed can help you understand what your care team is looking at and why moving quickly matters.
Foot Ulcer Classification
When an ulcer develops, clinicians use classification systems to assess how deep it is, whether infection is present and how well it's likely to heal. The Wagner scale grades ulcers from 0 to 5. SINBAD goes further, looking at six factors including blood supply, nerve damage and bacterial infection to build a clearer picture. Together these tools help determine the right treatment, how much offloading is needed and whether hospitalisation is required.
Charcot Neuroarthropathy
Charcot foot is less common but worth understanding. When neuropathy is severe, the bones and joints in the foot can weaken to the point where they begin to collapse, often without the person feeling any pain, making it quite dangerous. Picked up early, it can be managed well with total contact casting and later with bespoke footwear. Left too long, the structural damage can become permanent.
If your foot suddenly becomes swollen, warm or red, get it looked at straight away. And don't assume it's nothing just because it doesn't hurt.
Your Daily Foot Care Checklist
Consistent daily habits are among the most effective ways to prevent serious foot complications. If you're unsure about anything you find, contact your GP or foot health specialist.
- Wash your feet daily in lukewarm water and dry thoroughly, including between the toes
- Check both feet every day for blisters, cuts, cracks, redness or swelling
- Moisturise the soles and heels but avoid cream between the toes
- Never walk barefoot, including indoors
- Check inside your shoes before putting them on for objects or rough seams
- Trim toenails straight across and file any sharp edges
- Wear clean, seamless socks that aren't tight around the ankle or calf
- Avoid direct heat on your feet including hot water bottles and electric blankets
- Don't treat corns, calluses or ingrown toenails yourself
- Report any slow-healing wound, numbness or change in foot shape to your health professional promptly
Funding Diabetic Footwear in Australia
Quality diabetic footwear and orthotics are an important investment. Several funding pathways in Australia can reduce or even cover the cost.
NDIS
Funding for therapeutic footwear and orthotic devices may be available under the Assistive Technology category if your diabetes-related complications meet eligibility criteria. Clinical documentation from your treating team is generally required. Visit our referrals page.
My Aged Care
Older Australians with a Home Care Package may be able to access funding for diabetic footwear depending on their package level. Discuss this with your My Aged Care provider or care coordinator.
Private Health Insurance
Many funds cover custom orthotics and therapeutic footwear under extras cover. Amounts vary between policies, so check with your insurer before your appointment. A clinical referral can strengthen your claim.
Enhanced Primary Care Plans
If your GP refers you to podiatry under an Enhanced Primary Care plan, Medicare covers up to five allied health visits a year. It won't pay for the footwear itself, but it can take care of some of the assessment costs that lead to your prescription.
If you're unsure which pathway applies, our team can help.
Frequently Asked Questions
Diabetic foot care is about keeping a close eye on your feet, making sure your footwear is doing its job and seeing the right professionals regularly. It matters because diabetes affects both nerve function and circulation, which making feet more vulnerable to injury.
It depends on your IWGDF risk level, ranging from annually for those at low risk - to every one to three months for those with a history of ulceration or amputation.
A foot assessment covers nerve function, circulation, foot structure and footwear, usually including a monofilament and ABI test. Results set your IWGDF risk level and shape your care plan.
A podiatrist diagnoses and treats foot conditions clinically. A pedorthist specialises in footwear and orthotic prescription. At FBT, both are available.
Tingling, burning, numbness and reduced sensitivity to temperature or pain are common signs. Some people have no symptoms, which is why regular screening is important.
Sustained high blood sugar damages blood vessel walls, causing narrowing and reduced circulation in the feet. Risk increases with smoking, high blood pressure or high cholesterol.
Good diabetic footwear has extra depth, a rocker sole, seamless linings, adjustable fastenings and custom insoles. Off the shelf options vary, so a pedorthist prescription ensures what you're wearing suits your foot and your risk level.
A total contact cast takes pressure off an active ulcer or acute Charcot foot by spreading weight across the whole foot and lower leg. It's considered the best option for managing plantar ulcers.
Yes, if your diabetes-related complications meet eligibility criteria. Supporting clinical documentation is necessary. Our team can assist with the referral process.
Charcot foot happens when nerve damage weakens the bones and joints to the point of collapse. Catching it early is critical. A total contact cast is used first, then bespoke footwear once things have settled. .
A thin flexible filament is pressed against different points on the sole of your foot. If you can't feel it, that's a sign of nerve damage. It's a quick, painless test that's done as part of every diabetic foot check.
Foot Balance Technology offers diabetic foot assessments at our Castle Hill, Westmead and Campbelltown clinics. Call 1300 246 328 or book online.
Book a Diabetic Foot Assessment in Sydney
Quality diabetic footwear and orthotics are an important investment. Several funding pathways in Australia can reduce or even cover the cost.
If it's been a while since your feet were properly checked, it's worth making that appointment. At FBT we look at nerve function, circulation, foot structure and your current footwear, so you leave knowing exactly where you stand.
We see patients by referral or self-referral at our Castle Hill, Westmead and Campbelltown clinics, and we're happy to talk through funding options when you call.
Medically Reviewed by Dr. Sayed Ahmed (PhD, Pedorthics) on 18 July 2026
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